| NPI | 1205165016 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003174) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030638) |
| 363A00000X Physician Assistant (Licence: MD C0004120) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |