| NPI | 1679051536 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 1149) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 092569) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2021-11-03 |