| NPI | 1861769572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA939) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002675) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2016-03-10 |