| NPI | 1790954311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006961) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 011006) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2020-08-20 |