| NPI | 1568094498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007654) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-007654) |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2023-05-28 |