| NPI | 1811040892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08079) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 7112) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2021-03-29 |