| NPI | 1275107153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062615) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1164421) |
| Enumeration Date | 2021-05-16 |
| Last Update Date | 2021-10-13 |