| NPI | 1578074043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012191) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9110616) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2023-03-15 |