| NPI | 1790055523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4388) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2019-02-07 |