| NPI | 1861275919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064728) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006556) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2025-01-13 |