| NPI | 1356998108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11111) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2024-09-18 |