| NPI | 1891417713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119211) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8963) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2024-12-19 |