| NPI | 1205306156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026591-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08509) |
| 363A00000X Physician Assistant (Licence: MO 2020017114) | |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2021-12-10 |