| NPI | 1740899400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 324365) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA Pending) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2022-12-28 |