| NPI | 1518290428 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000830) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053980) | 
| Enumeration Date | 2009-09-09 | 
| Last Update Date | 2017-11-10 |