| NPI | 1891786166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 1004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 3581) |
| 363A00000X Physician Assistant (Licence: OK 2991) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2019-01-21 |