| NPI | 1679775589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002407) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD c0003515) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2021-06-02 |