| NPI | 1689088312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056901) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003304) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |