| NPI | 1609149111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9107939) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015441) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2019-08-13 |