| NPI | 1972546596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 417) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SD 0417) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-07-17 |