| NPI | 1619145067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017086) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001584-1) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2025-01-30 |