| NPI | 1760172761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119031) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064732) |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2024-12-18 |