| NPI | 1558826719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA6499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009995) |
| 363A00000X Physician Assistant (Licence: CA PA56519) | |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2025-08-12 |