| NPI | 1174567374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 4787-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109437) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00071900) | |
| 363A00000X Physician Assistant (Licence: KY PA 1739) | |
| 363A00000X Physician Assistant (Licence: IL 085004287) | |
| 363A00000X Physician Assistant (Licence: OH 50.003029) | |
| 363A00000X Physician Assistant (Licence: NY 004787) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-06-09 |