| NPI | 1457778003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000963) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA056754) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2021-11-15 |