| NPI | 1770121832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MA061338) |
| 207Q00000X Family Medicine (Licence: PA OA005148) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2020-02-01 |