| NPI | 1417693003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C08432) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: VA 0110008506) | |
| Enumeration Date | 2022-05-07 |
| Last Update Date | 2022-12-08 |