| NPI | 1164767653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055822) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007845) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2025-11-04 |