| NPI | 1790792836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 641) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1233) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-02-02 |