| NPI | 1811652522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005906) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2022-05-11 |