| NPI | 1760720155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR 517) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2179) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2013-06-10 |