| NPI | 1972089969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7394) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 092825) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2021-01-15 |