| NPI | 1386954923 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008265) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 5974) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2022-03-23 |