| NPI | 1972239168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100688) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2024-0023) |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2026-01-20 |