| NPI | 1952731564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061389) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51322) |
| 363A00000X Physician Assistant (Licence: MA PA5011) | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2020-09-30 |