| NPI | 1164712071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA4681) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NH 0822) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2025-04-30 |