| NPI | 1154537264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016663) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005018) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-05-12 |