| NPI | 1619799541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066138) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012201) |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2024-12-20 |