| NPI | 1558668301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004915) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002622) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2021-06-17 |