| NPI | 1306839485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 005748) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 005748) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-08-13 |