| NPI | 1972145548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 9112694) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-02-15 |