| NPI | 1467262162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 4381809) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-147740) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2026-04-21 |