| NPI | 1639711526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061181) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MA061181) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2021-08-11 |