| NPI | 1164795670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 15442) |
| 363A00000X Physician Assistant (Licence: ME PA1940) | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2024-06-24 |