| NPI | 1104663756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 6132) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10612) |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2025-11-21 |