| NPI | 1609127174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 6703) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2205) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2022-07-21 |