| NPI | 1215471859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA1635) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1799) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2019-01-29 |