| NPI | 1902457385 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006891) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA065545) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2024-07-25 |