| NPI | 1154736932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028267) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5040) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-11-10 |