| NPI | 1598063851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-949) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2016-11-10 |