| NPI | 1821402454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056914) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005547) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA056914) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2024-01-03 |