| NPI | 1215302310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019077) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2023-09-06 |