| NPI | 1750573820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1649) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00165800) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 011369-1) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2018-06-05 |