| NPI | 1912413568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059405) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MD059405) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2021-11-30 |