| NPI | 1922653336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13588) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 5912) |
| 363A00000X Physician Assistant (Licence: IA 097935) | |
| Enumeration Date | 2019-08-03 |
| Last Update Date | 2024-02-22 |