| NPI | 1184091738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057755) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005134) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2021-10-05 |