| NPI | 1750562286 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002264) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2217-23) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2012-04-19 |