| NPI | 1669087615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4334) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: GA 10105) | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2024-01-10 |