| NPI | 1417971011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 009580) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007643) |
| 363A00000X Physician Assistant (Licence: NY 009580) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-03-24 |