| NPI | 1467887067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4801) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016909) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2018-12-03 |