| NPI | 1710639257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 202204195961) |
| Additional Taxonomies | 261Q00000X |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2023-01-17 |