| NPI | 1154043057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064067) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006468) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-09-25 |