| NPI | 1356673164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0007806) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04243) |
| 363A00000X Physician Assistant (Licence: NY 013832-01) | |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2023-02-02 |