| NPI | 1740520121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03911) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2020-06-02 |