| NPI | 1649818816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07968) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007830) |
| 363A00000X Physician Assistant (Licence: MD c0007968) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2021-11-11 |