| NPI | 1326615212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 376K00000X Nurse's Aide (Licence: MA 112199) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-11-09 |