| NPI | 1861882722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 022477-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057294) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110005060) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2022-03-25 |