| NPI | 1740954643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4706) |
| Additional Taxonomies | 171400000X (Licence: UC-51980AFD-1B01-483) |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: MS PA00599) | |
| 363AM0700X Physician Assistant Medical | |
| 363AM0700X Physician Assistant Medical (Licence: TN 4706) | |
| 363AM0700X Physician Assistant Medical (Licence: MS PA00599) | |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-04-06 |