| NPI | 1376946749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057137) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003385) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2015-11-18 |