| NPI | 1902646524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15709) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 5404) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2025-09-10 |