| NPI | 1811242621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05889) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA002871) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2016-11-18 |