| NPI | 1124206131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6851557-8906) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016525) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2016-08-25 |