| NPI | 1407845654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052540) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102515) |
| 363A00000X Physician Assistant (Licence: DE C50000622) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2023-03-07 |