| NPI | 1386097038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8039) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07290) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2022-09-06 |