| NPI | 1104086487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6748) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 005485) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2025-05-02 |