| NPI | 1891227807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029783) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003233) |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: PA MA064317) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2023-04-24 |