| NPI | 1679754329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019033838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 012059-1) |
| 363A00000X Physician Assistant (Licence: MD C04020) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2020-05-18 |