| NPI | 1093759078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5392) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 001410) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA5392) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-04-30 |