| NPI | 1912778218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 001629) |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2025-02-26 |