| NPI | 1306833702 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2008004931) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 878) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2010-02-03 |