| NPI | 1639594963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056679) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2022-07-01 |