| NPI | 1770741324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001008296) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053823) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2018-12-21 |