| NPI | 1134364912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01589) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1395) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2013-06-27 |