| NPI | 1104248772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA AO004787) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08773) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00437800) | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2024-08-14 |