| NPI | 1730521667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001555A) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN 2669) |
| 363AS0400X Physician Assistant Surgical (Licence: TN 2669) | |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2015-10-09 |