| NPI | 1992180160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05854) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2018-05-01 |