| NPI | 1962502245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MA 1176) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA1176) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-10-08 |