| NPI | 1982913356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5339) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 3121) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2014-01-01 |