| NPI | 1770553331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002246) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1500966) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2011-10-05 |