| NPI | 1134873490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00610) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-03-20 |