| NPI | 1558790774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10364) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NJ 25MP00315700) | |
| 363A00000X Physician Assistant (Licence: NY 016599) | |
| 363A00000X Physician Assistant (Licence: CA 58047) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2022-08-19 |