| NPI | 1174138887 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10927) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2021-11-09 |