| NPI | 1548269434 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC169) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 011791) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA5579) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2024-04-18 |