| NPI | 1457035313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064912) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-03-14 |