| NPI | 1669906012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6589) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005735) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2018-09-14 |