| NPI | 1629448501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 4357) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0005948) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2022-06-23 |