| NPI | 1649717661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA066232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020525-1) |
| Enumeration Date | 2017-01-28 |
| Last Update Date | 2025-06-12 |