| NPI | 1871230417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008656) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-10-07 |