| NPI | 1760621502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01739) |
| 363A00000X Physician Assistant (Licence: IN 9904821A.) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2017-01-24 |