| NPI | 1780840934 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA057349) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110002822) |
| 363A00000X Physician Assistant (Licence: PA MA057349) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2016-09-14 |