| NPI | 1508400565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029809-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-12699) |
| Enumeration Date | 2019-11-03 |
| Last Update Date | 2023-10-27 |