| NPI | 1962562801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000891AB) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: IN 10000891A) |
| 363A00000X Physician Assistant (Licence: KY PA745) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-11-08 |