| NPI | 1386157519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6413) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021651) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2019-06-12 |