| NPI | 1568918308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059766) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004450) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2021-06-23 |