| NPI | 1750374666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1108) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001733) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2017-08-17 |