| NPI | 1861467565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052085) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-00781) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2012-05-01 |