| NPI | 1306847843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002765) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2022-12-20 |