| NPI | 1922670306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1177817) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2022-12-04 |