| NPI | 1689665135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA1875) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 1875) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2021-02-13 |