| NPI | 1912771148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13647) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-12-29 |