| NPI | 1962755538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002790) |
| 363A00000X Physician Assistant (Licence: MI 5601007021) | |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2020-04-24 |