| NPI | 1942995402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009091) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-12-30 |