| NPI | 1114436763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022292) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2020-03-20 |