| NPI | 1275096158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001011689) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 023671) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2023-06-20 |