| NPI | 1679149926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062571) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005799) |
| 363A00000X Physician Assistant (Licence: WV 2486) | |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2023-10-24 |