| NPI | 1003894080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001196) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2021-02-02 |