| NPI | 1659019388 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9237) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9119708) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-04-04 |