| NPI | 1932104395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 1438) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 1740) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2013-07-23 |