| NPI | 1811243470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA003455) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0004797) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2015-01-27 |