| NPI | 1902116460 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4760) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 7798445-1206) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2011-11-16 |