| NPI | 1194272062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005174) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005174) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005174) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |