| NPI | 1962734046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005804) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5804) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 5804) | |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2022-11-04 |