| NPI | 1164996732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065523) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9111871) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-07-15 |