| NPI | 1972526630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA A10562) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PAA10562) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-05-01 |