| NPI | 1942811559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 351703) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: LA 86117006) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2026-05-01 |