| NPI | 1942827795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7691) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA PA7691) |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2021-01-15 |