| NPI | 1740590595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07068) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054580) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2019-06-26 |