| NPI | 1922710615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100969) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 029309) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2025-07-24 |