| NPI | 1558763896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA003359L) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA003359L) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2016-03-03 |