| NPI | 1629054853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 1100001674) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030289) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2014-03-07 |