| NPI | 1376956425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4901) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2021-09-13 |