| NPI | 1720532757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10654) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 363AM0700X Physician Assistant Medical (Licence: LA 1134432) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2024-03-13 |