| NPI | 1043832686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001014621) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 322114) |
| Enumeration Date | 2020-05-16 |
| Last Update Date | 2025-04-21 |