| NPI | 1861064735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA005721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062597) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2022-04-26 |