| NPI | 1083160089 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1725) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06158) | 
| Enumeration Date | 2016-08-30 | 
| Last Update Date | 2021-05-26 |