| NPI | 1750794459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004599) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-004599) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2023-01-13 |