| NPI | 1851862544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 1243) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008846) |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2020-10-01 |