| NPI | 1568799476 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005726) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2021-03-31 |