| NPI | 1902161466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 25709) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: med-pac-lic-25709) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-09-04 |