| NPI | 1154878957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0006408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058453) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2021-08-20 |