| NPI | 1205408275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 328003) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: LA 328003) |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2021-08-16 |