| NPI | 1912179623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002094L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004432) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2020-11-05 |