| NPI | 1962145284 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9506) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2259) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-01-16 |