| NPI | 1871686287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001787) |
| 363A00000X Physician Assistant (Licence: KY TC022) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2013-08-23 |