| NPI | 1053076422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029513) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2021046325) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2023-03-21 |