| NPI | 1639905599 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA101027) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2024-12-29 |