| NPI | 1275970600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09077) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001009077) |
| 363A00000X Physician Assistant (Licence: NY 016582) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2019-07-23 |