| NPI | 1023766169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100805) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2024-11-01 |