| NPI | 1902514987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9117) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2023-01-19 |