| NPI | 1306462569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064682) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006828) |
| 363A00000X Physician Assistant (Licence: NC 0010-10955) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-09-18 |