| NPI | 1053733394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 2021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8248-23) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2025-02-04 |