| NPI | 1568815348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7289) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019817-1) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2019-04-04 |