| NPI | 1750533071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-24421) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 19670) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2013-06-21 |