| NPI | 1104697309 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031212) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 6402) |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-01-16 |