| NPI | 1639422983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 006508) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 06508) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2018-09-25 |