| NPI | 1245798032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 9190) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: GA 9190) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2020-07-28 |