| NPI | 1114471562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0005919) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-704) |
| Enumeration Date | 2016-08-14 |
| Last Update Date | 2022-10-24 |