| NPI | 1689345076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4133) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11782) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2022-01-04 |