| NPI | 1659017184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4170) |
| 363A00000X Physician Assistant (Licence: NY 027589) | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-25 |