| NPI | 1326862582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-16045) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2025-12-30 |