| NPI | 1518217447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 5219) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 116249) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2022-10-17 |