| NPI | 1366175101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02790) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2023-09-19 |