| NPI | 1578655676 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007520) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-09-25 |