| NPI | 1043512973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019641) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054698) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 019641) | |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2021-02-05 |