| NPI | 1679163141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10961) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1175830) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-04-29 |