| NPI | 1790867117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 2825) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 103816) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2018-09-18 |