| NPI | 1659845642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6888) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9111636) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-07-12 |