| NPI | 1649766494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008734) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2020-11-04 |