| NPI | 1578249603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064813) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006532) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-07-23 |