| NPI | 1912510850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010303) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MP 114) |
| Enumeration Date | 2020-08-29 |
| Last Update Date | 2025-01-17 |