| NPI | 1235136649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20721) |
| 363A00000X Physician Assistant (Licence: NC 0010-00132) | |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50001934) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-11-15 |