| NPI | 1285989806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020068) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004637) |
| 363A00000X Physician Assistant (Licence: IN 10001433A) | |
| 363A00000X Physician Assistant (Licence: MA PA5213) | |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004435) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2020-01-16 |