| NPI | 1568236578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025040869) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 5666) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2026-01-29 |