| NPI | 1851779110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057396) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003461) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA057396) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2018-04-18 |