| NPI | 1649548801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-007100) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: HI AMD-585) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2021-01-13 |