| NPI | 1760769509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03589) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015270-1) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2024-05-07 |