| NPI | 1114966686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA051057) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000816) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-10-05 |