| NPI | 1528614906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 7159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 107559) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2023-02-14 |