| NPI | 1972998144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5774) |
| 363A00000X Physician Assistant (Licence: NH 1100) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-04-16 |