| NPI | 1548923188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028162) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-11521) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2022-04-26 |