| NPI | 1114514049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062332) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001013211) |
| Enumeration Date | 2020-12-27 |
| Last Update Date | 2023-10-12 |