| NPI | 1790111797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017013) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05824) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2023-09-26 |