| NPI | 1134505373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058712) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 007634) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2017-12-18 |