| NPI | 1013474733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT005652) |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2021-07-01 |