| NPI | 1659189876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 138121) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 146030) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2026-07-14 |