| NPI | 1376969576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 017427) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 017427) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2022-02-09 |