| NPI | 1689659310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004536) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2020-10-20 |