| NPI | 1609242957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 019027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057509) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2021-05-05 |