| NPI | 1063865442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0006186) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059007) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-01-27 |