| NPI | 1063552487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA8022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004819-1) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00141700) | |
| 363AM0700X Physician Assistant, Medical (Licence: WY PA1010) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-02-03 |