| NPI | 1972879633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001007446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015547) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2022-12-13 |