| NPI | 1205347531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004310) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2021-11-04 |