| NPI | 1316939655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: NY 007986) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0079861) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2019-12-10 |