| NPI | 1407502685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0008363) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2024-04-27 |