| NPI | 1518415843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AZ 9168) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 1995) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2022-10-20 |