| NPI | 1912056003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MD C03495) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-12-14 |