| NPI | 1992150270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 9660) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 019650) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2021-03-11 |