| NPI | 1760823132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11372) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016560-1) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA4702) | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2024-01-01 |