| NPI | 1124674270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060718) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA060718) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2022-09-27 |