| NPI | 1568933232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5783) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 023033) |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2022-05-04 |