| NPI | 1174266670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11072) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-08-18 |