| NPI | 1063053528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 033509) |
| 363A00000X Physician Assistant (Licence: CA PA65443) | |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2025-05-09 |