| NPI | 1780955336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004428) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2018-04-09 |