| NPI | 1629470661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA187788) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 017939) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2019-12-03 |