| NPI | 1316944143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023977) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2004-0007) |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2004-0007) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-05-13 |