| NPI | 1265993968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062887) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023439) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2021-12-20 |