| NPI | 1154708402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NC 0010-05730) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: NC 0010-05730) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2020-08-27 |