| NPI | 1316339088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA188907) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018490) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 018490) | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2020-02-07 |