| NPI | 1124797030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063546) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 12458330-1206) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2022-06-24 |