| NPI | 1902100373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL 1612) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2016-12-05 |