| NPI | 1134643372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009819) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012073) |
| 363A00000X Physician Assistant (Licence: WI 5422) | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2025-09-11 |