| NPI | 1730497918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-007135) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10296) |
| 363A00000X Physician Assistant (Licence: MD 1093616) | |
| 363A00000X Physician Assistant (Licence: NC 0010-11122) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2024-01-11 |