| NPI | 1205405479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11366) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2022-01-10 |