| NPI | 1295515542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 228691) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13639) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2025-06-10 |