| NPI | 1619518222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10205) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 10205) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2021-10-15 |