| NPI | 1962159541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4989) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10885) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2025-10-01 |