| NPI | 1477244218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2500) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: ID PA-2500) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-09-03 |