| NPI | 1902147176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1943) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IN 10001501A) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2023-11-09 |