| NPI | 1063611143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WI 4262) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 902) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2018-01-23 |