| NPI | 1356987747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061284) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005108) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-12-15 |