| NPI | 1790864148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003134) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010938) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-12-28 |