| NPI | 1184063281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4796) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1183) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-02-19 |