| NPI | 1467604561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027348) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL1364) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 27348) | |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2023-07-17 |