| NPI | 1114340411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05704) |
| 363A00000X Physician Assistant (Licence: PA MA056713) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-08-27 |