| NPI | 1194314807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8543) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2022-07-14 |