| NPI | 1619525045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 10918) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2022-03-16 |