| NPI | 1487834099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL 9103262) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AL PA575) |
| 363AM0700X Physician Assistant Medical (Licence: AZ 4657) | |
| 363AM0700X Physician Assistant Medical (Licence: GA 4168) | |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2014-03-05 |