| NPI | 1629743315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 118667) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-08-29 |