| NPI | 1205590791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 12533611-1206) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2021-12-30 |