| NPI | 1245647148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059205) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017724) |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2020-10-07 |