| NPI | 1629707351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110008376) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: VA 0110008376) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-05-27 |