| NPI | 1104585124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12087) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4291) |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2023-11-03 |