| NPI | 1033469317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0101250786) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04783) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2016-10-21 |