| NPI | 1639801459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 032218) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA PA8874) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-03-12 |