| NPI | 1912461575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006484) |
| 363A00000X Physician Assistant (Licence: MA060483) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2025-08-26 |