| NPI | 1912545757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WI 342329) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2025-05-01 |