| NPI | 1629562814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6588) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-07-24 |