| NPI | 1487222188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15498) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 5241) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-11-05 |