| NPI | 1548634066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 001005816) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05816) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2021-03-12 |