| NPI | 1538364948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001002163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0109211) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2015-01-08 |