| NPI | 1073921094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003607) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA018126) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA057031) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-10-31 |