NPI | 1164796009 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 008438) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061645) |
363A00000X Physician Assistant (Licence: GA 004588) | |
363A00000X Physician Assistant (Licence: NJ 25MP00040500) | |
Enumeration Date | 2012-02-23 |
Last Update Date | 2025-08-20 |