| NPI | 1750624300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA A10501) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9106086) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-04-02 |