| NPI | 1588783195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054414) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011683) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-02-15 |