| NPI | 1821745860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4279) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-05-17 |