| NPI | 1568181543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115536) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-08-29 |