| NPI | 1366955445 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6377) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1147614) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2020-07-20 |