| NPI | 1376908012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5958) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1093) |
| 363A00000X Physician Assistant (Licence: GA 7827) | |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2022-04-09 |