| NPI | 1487289088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007105) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063470) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2023-08-24 |