| NPI | 1104315993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6559) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6659) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2019-08-30 |