| NPI | 1417258567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002496) |
| 363A00000X Physician Assistant (Licence: MD C0004284) | |
| 363A00000X Physician Assistant (Licence: DC PA030823) | |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2014-06-06 |