| NPI | 1962023689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 10890) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-007114) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2022-11-05 |