| NPI | 1023564283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064762) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2024-09-17 |