| NPI | 1366563496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK PA 218) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2367) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |