| NPI | 1043684418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05823) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00634200) |
| 363A00000X Physician Assistant (Licence: CA 66336) | |
| 363A00000X Physician Assistant (Licence: MA PA100661) | |
| Enumeration Date | 2015-11-22 |
| Last Update Date | 2026-05-05 |