| NPI | 1750855797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008163) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: GA 9939) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2022-01-03 |