| NPI | 1376880237 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002458A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2013005681) |
| 363A00000X Physician Assistant (Licence: NM PA2015-0055) | |
| 363A00000X Physician Assistant (Licence: IL 085005263) | |
| Enumeration Date | 2013-01-12 |
| Last Update Date | 2022-06-03 |