| NPI | 1164209078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA007204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 953) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2025-12-02 |