| NPI | 1407140775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 14585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-02916) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-02916) | |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2017-10-25 |