| NPI | 1386668572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 110003747) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05335) |
| 363A00000X Physician Assistant (Licence: AK 667) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-05-31 |