| NPI | 1154382646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103649) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 012273-1) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2010-06-01 |