| NPI | 1003971714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 2109) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23005919) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-12-04 |