| NPI | 1467789560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054238) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-02104) |
| 363A00000X Physician Assistant (Licence: AZ 5016) | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2022-11-16 |