| NPI | 1407311525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060511) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004776) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA060511) | |
| Enumeration Date | 2019-02-02 |
| Last Update Date | 2020-08-28 |