| NPI | 1346592169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001004291) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003998) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2013-07-26 |