| NPI | 1790258911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060406) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004712) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-04-08 |