| NPI | 1013633205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 1484) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10431) |
| 363AM0700X Physician Assistant, Medical (Licence: FL TPPA379) | |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2024-09-11 |