| NPI | 1558640011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058779) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014920) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2024-03-14 |