| NPI | 1538835442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA S11651435) |
| 363A00000X Physician Assistant (Licence: MA 11651435) | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-09-08 |