| NPI | 1174928386 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5207) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1480) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2022-07-13 |