| NPI | 1619425675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8279) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109806) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2021-06-17 |