| NPI | 1891191219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057134) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003382) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2021-01-28 |