| NPI | 1780685602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053064) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 103506) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2014-10-20 |