| NPI | 1790812881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05488) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001001210) |
| 363A00000X Physician Assistant (Licence: NY 008902) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2024-01-30 |