| NPI | 1902177199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2141) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 4558) |
| 363AM0700X Physician Assistant Medical (Licence: ID PA-2141) | |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2024-05-13 |