| NPI | 1285052167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004473) |
| 363A00000X Physician Assistant (Licence: NY 017469) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2018-03-17 |