| NPI | 1053910596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3871) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NC 0010-12293) | |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2024-06-19 |