| NPI | 1073922209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063482) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 13598623-1206) |
| 363A00000X Physician Assistant (Licence: NY 017813) | |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2024-09-05 |