| NPI | 1619584869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7812) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2022-01-20 |