| NPI | 1700847506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA4622) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA002657L) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA002657L) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-09-14 |