| NPI | 1205355112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059354) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2021-03-09 |