| NPI | 1730511692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059831) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016679) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2025-08-11 |