| NPI | 1104312024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112362) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-08-09 |