| NPI | 1780382994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24188) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 1562) |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2025-02-24 |