| NPI | 1669846200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08373) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019197) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2019-06-13 |