| NPI | 1407408537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025034236) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 7744) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2025-10-15 |