| NPI | 1467678193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001874) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: VA 0002054911) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2023-08-11 |