| NPI | 1639111081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA1686) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C02846) |
| 363A00000X Physician Assistant (Licence: MA 1686) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-07-05 |