| NPI | 1124725734 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 6161875) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1205270) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2025-02-24 |