| NPI | 1619367406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110143) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0167861) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 0167861) | |
| Enumeration Date | 2015-01-31 |
| Last Update Date | 2020-06-25 |