| NPI | 1821769514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005750) |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2021-11-29 |