| NPI | 1770467797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1229653) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WI 86290411) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-11-14 |