| NPI | 1801138227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-970) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA176262) |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2025-07-15 |