| NPI | 1164968244 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06833) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2022-02-16 |