| NPI | 1003807934 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001743) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0003486) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-02-06 |