| NPI | 1669077202 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008504) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025708-01) | 
| Enumeration Date | 2020-12-02 | 
| Last Update Date | 2025-01-06 |