| NPI | 1831643105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PA186127) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 3727) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2021-12-15 |