| NPI | 1760569958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005756) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085003014) |
| 363A00000X Physician Assistant (Licence: TX PA04049) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-05-17 |