| NPI | 1679690978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 071156) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 1523) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 001523) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-03-07 |