| NPI | 1790375665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062501) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025930) |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2022-07-13 |