| NPI | 1154625010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014509) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014509-1) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2021-05-19 |