| NPI | 1720723109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008727) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008771) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2024-01-10 |