| NPI | 1366622680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061266) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 3978) |
| 363A00000X Physician Assistant (Licence: NH 0944) | |
| 363A00000X Physician Assistant (Licence: AK 1943) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2019-12-19 |