| NPI | 1477596559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011859) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA2037) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-10-23 |