| NPI | 1568123610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 2471259) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: ID 2471259) |
| 207Q00000X Family Medicine (Licence: ID 2471259) | |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2026-03-27 |