| NPI | 1548242258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001-00194) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA200042) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2024-06-20 |