| NPI | 1336675180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NY 317277) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 317277) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-07-17 |