| NPI | 1194389353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13643) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9798) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2024-01-19 |