| NPI | 1770869596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04570) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0004570) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2019-09-01 |