| NPI | 1053510701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06146) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-03-31 |