| NPI | 1457742405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06008) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ZZ PA9108540) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL Pa9108540) | |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2016-02-23 |