| NPI | 1780775486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 005769-1) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-09-25 |