| NPI | 1679581391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014390) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005617) |
| 363A00000X Physician Assistant (Licence: NC 0010-00718) | |
| 363A00000X Physician Assistant (Licence: VA 0110002784) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-07-01 |