| NPI | 1548881832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7517) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA pending) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2020-12-03 |