| NPI | 1629873419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5750) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 6427) |
| Enumeration Date | 2025-02-15 |
| Last Update Date | 2025-07-22 |