| NPI | 1982974556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1804) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03320) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2016-08-10 |