| NPI | 1558641746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04892) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 0066443) |
| 363A00000X Physician Assistant (Licence: SC 1669) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2021-12-29 |