| NPI | 1063479608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00133) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004472) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2010-06-23 |