| NPI | 1194964635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15912) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110011314) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2026-02-02 |