| NPI | 1194391201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8138) |
| Enumeration Date | 2021-05-29 |
| Last Update Date | 2021-12-14 |