| NPI | 1972572808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102257) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-04-10 |