| NPI | 1982786752 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 19770) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2005031147) |
| 363AM0700X Physician Assistant, Medical (Licence: KS 1501035) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2009-10-01 |