| NPI | 1821611732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4255) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007447) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2020-10-14 |