| NPI | 1487836961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006327) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C07550) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601005001) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2023-01-09 |