| NPI | 1235489139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-91714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015681) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2021-09-23 |