| NPI | 1457705790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0006103) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |