| NPI | 1699444547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA 1183001) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2021-10-29 |