| NPI | 1376740688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA002204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003259) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2025-08-29 |