| NPI | 1861678997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: IA 001879) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SD 0744) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2021-06-14 |