| NPI | 1205455078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027217) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006299RX) |
| 363A00000X Physician Assistant (Licence: NC 0010-09913) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2023-11-17 |