| NPI | 1144520560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1603) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA 9106012) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2021-12-08 |