| NPI | 1982367454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008173) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 027001) |
| 363A00000X Physician Assistant (Licence: VA 0110-007994) | |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2022-06-24 |