| NPI | 1619646999 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10563) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 027125) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2021-09-09 |