| NPI | 1710694112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006292) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |