| NPI | 1295075992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5256) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03731) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2021-04-15 |