| NPI | 1902877624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-928) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102051) |
| 363A00000X Physician Assistant (Licence: ID 928) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2017-01-13 |