| NPI | 1750617874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001002003) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02003) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2017-10-02 |