| NPI | 1912202664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001167) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001667) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2023-11-27 |