| NPI | 1588962815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1583) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002187) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2014-09-10 |