| NPI | 1275013823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6720) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1540) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2020-01-13 |