| NPI | 1619472792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004535) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059919) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2018-07-20 |