| NPI | 1619687225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064268) |
| 363A00000X Physician Assistant (Licence: PA OA006340) | |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-01-08 |