| NPI | 1073067815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL 9109892) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 12765) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2020-10-14 |