| NPI | 1164151452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5450) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 11136) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2024-11-20 |