| NPI | 1073527792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003241) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-12-21 |