| NPI | 1992858104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2292) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA AP2292) |
| 363AM0700X Physician Assistant, Medical (Licence: MA AP2292) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2021-03-26 |