| NPI | 1083967483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4999) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 2846) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2021-12-08 |