| NPI | 1649758475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA059977) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059977) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2018-09-12 |