| NPI | 1992071641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL 9104181) |
| 363AM0700X Physician Assistant Medical (Licence: NC 0010-03862) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2021-03-23 |