| NPI | 1255824504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063195) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001236) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-12-17 |