| NPI | 1710462957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024056) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: PA MA060323) | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2024-08-20 |