| NPI | 1346632346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3512-23) |
| 363AM0700X Physician Assistant Medical (Licence: MI 5601008750) | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-04-19 |