| NPI | 1104667674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004605A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA3479) |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-11-05 |