| NPI | 1407531817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 120696) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NE 2942) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-07-05 |