| NPI | 1790780245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002032L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000239L) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2014-07-29 |