| NPI | 1871216721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14307) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 12360) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2025-07-16 |