| NPI | 1861563926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2012001745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030416) |
| 363A00000X Physician Assistant (Licence: MD C0003268) | |
| 363A00000X Physician Assistant (Licence: VA 0110002219) | |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2015-05-13 |