| NPI | 1245758739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5334) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008291) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-08-16 |