| NPI | 1356643613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1602) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2018-06-18 |