| NPI | 1609953231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 23 018257) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0003424) |
| 363A00000X Physician Assistant (Licence: MN 10629) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA ma052708) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-01-03 |