| NPI | 1639228695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052881) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052881) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-03-23 |