| NPI | 1619674439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14674) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4867) |
| 363A00000X Physician Assistant (Licence: TN 5415) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2024-12-14 |