| NPI | 1891805115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001399) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 999) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-02-09 |