| NPI | 1821697590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2751) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA2022-0084) |
| 363A00000X Physician Assistant (Licence: NM PA2022-0084) | |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2022-084) | |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2024-04-26 |