| NPI | 1073209664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA101235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117308) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-05-28 |