| NPI | 1255893301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1054) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7564) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2021-06-15 |