| NPI | 1124619283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA217576) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025656) |
| 363L00000X Nurse Practitioner (Licence: NY 025656) | |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2024-04-09 |