| NPI | 1700290152 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 65) | 
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 7190) | 
| Enumeration Date | 2014-06-13 | 
| Last Update Date | 2019-06-27 |