| NPI | 1861584963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9076173-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 4034) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-07-05 |