| NPI | 1164809000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 303819) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001005497) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2017-03-16 |