| NPI | 1003540634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 11069) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-10-12 |