| NPI | 1639859531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13550) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: NC 0010-13550) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2024-07-19 |