| NPI | 1326342130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04232) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363A00000X Physician Assistant (Licence: MD C0004232) | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2019-11-26 |