| NPI | 1548707979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060353) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA060353) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2022-08-19 |