| NPI | 1689378705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23320) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PR 802-PA) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-06-25 |