| NPI | 1104433382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10525) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10656) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-10-20 |