| NPI | 1053090175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OA006521) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064631) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-07-17 |