| NPI | 1649764853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059810) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA004483) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-11-01 |