| NPI | 1922202555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105050) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-08-01 |