| NPI | 1891349098 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024029) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA57042) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2019-10-21 |