| NPI | 1063156982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026913) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2024-02-22 |