| NPI | 1780876045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 002791) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NH 0130) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2013-06-04 |