| NPI | 1679445761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110011586) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA b61703803) |
| Enumeration Date | 2025-09-19 |
| Last Update Date | 2026-03-13 |