| NPI | 1063949980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012255) |
| 363A00000X Physician Assistant (Licence: MD C0006517) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-04-08 |