| NPI | 1639405749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7385) |
| 363A00000X Physician Assistant (Licence: OH 002991) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2017-06-13 |