| NPI | 1699395210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026348) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MT MED-PAC-LIC-96642) |
| 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-96642) | |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2022-07-05 |