| NPI | 1730184375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 2624) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004199) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2016-01-14 |