| NPI | 1912241183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002346) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IA 002346) |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2024-03-27 |