| NPI | 1558375782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 164) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23-010594) |
| 363A00000X Physician Assistant (Licence: NM PA2006-0032) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |