| NPI | 1881050540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA1897) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9109214) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2022-01-18 |