| NPI | 1417411349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062350) |
| 363A00000X Physician Assistant (Licence: TN 4258) | |
| 363A00000X Physician Assistant (Licence: MS PA00517) | |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2023-02-10 |