| NPI | 1609144088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024979) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10884) |
| 363A00000X Physician Assistant (Licence: CA PA22020) | |
| 363A00000X Physician Assistant (Licence: AZ 7793) | |
| 363A00000X Physician Assistant (Licence: TX PA14151) | |
| 363A00000X Physician Assistant (Licence: WA PA61026917) | |
| 363A00000X Physician Assistant (Licence: MA PA8892) | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2023-02-16 |