| NPI | 1295109650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05987) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD C05987) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2020-12-27 |