| NPI | 1063789352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015297) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4977) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2021-01-19 |