| NPI | 1790652030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA067258) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA007502) |
| Enumeration Date | 2025-10-21 |
| Last Update Date | 2026-01-19 |