| NPI | 1962979591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6767) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 1148320) |
| 363A00000X Physician Assistant (Licence: MA 1148320) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA 1148320) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2019-01-07 |