| NPI | 1568942019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060039) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004585) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2019-11-21 |