| NPI | 1497218036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA209966) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00539600) |
| 363A00000X Physician Assistant (Licence: PA MA060529) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-02-01 |