| NPI | 1568588812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10837) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011124) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 011124) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2024-02-19 |