| NPI | 1194594036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14225) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5019933) | |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2024-08-22 |