| NPI | 1255356077 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012627) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052589) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-02-12 |