| NPI | 1760759518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110005883) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005883) |
| 363A00000X Physician Assistant (Licence: PA MA055021) | |
| 363A00000X Physician Assistant (Licence: NY 018560-1) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2022-11-11 |