| NPI | 1629547518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 023021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031489) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2022-08-31 |