| NPI | 1396411898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13741) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8224) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-11-01 |