| NPI | 1023516754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07920) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4500) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2026-04-28 |