| NPI | 1891136446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 031911) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: ND 18872330) |
| 363A00000X Physician Assistant (Licence: MN 13088) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2024-07-18 |