| NPI | 1073774899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 012666) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8714) |
| 363A00000X Physician Assistant (Licence: NC 0010-13119) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2023-03-15 |