| NPI | 1861822009 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007305) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4882) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2020-09-29 |