| NPI | 1619258985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059786) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3250) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2018-08-07 |