| NPI | 1558876680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061162) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005884) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2020-02-04 |