| NPI | 1255577581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0001667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000548) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2017-05-30 |