| NPI | 1790922144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5950) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002725) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2017-02-16 |