| NPI | 1548659857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004795) |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2022-11-09 |