| NPI | 1801108311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 2656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52263) |
| 133V00000X Dietitian, Registered (Licence: OK 1677) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2020-08-12 |