| NPI | 1104021690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003229) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008266) |
| 363A00000X Physician Assistant (Licence: FL pa9104678) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2015-07-24 |