| NPI | 1225349772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR 187062) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3020) |
| 363A00000X Physician Assistant (Licence: OK 2156) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2019-08-01 |