| NPI | 1821611310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL 9117453) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024907) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2023-06-26 |