| NPI | 1790404168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2907) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 116920) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2025-09-23 |