| NPI | 1083888739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02639) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012505) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2012-04-05 |