| NPI | 1962808881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 310327) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2019-02-08 |