| NPI | 1073854956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1862) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1862) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03938) | |
| Enumeration Date | 2013-03-02 |
| Last Update Date | 2024-04-01 |