| NPI | 1942785621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA064481) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 022644) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2023-07-25 |