| NPI | 1043837404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2019) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2026-04-29 |