| NPI | 1760293021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119952) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 1221554) |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-04-17 |