| NPI | 1104039890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0005446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022215) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2023-10-19 |