| NPI | 1154953289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007641) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2022-12-14 |