| NPI | 1043807795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA005508) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062250) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2022-05-05 |