| NPI | 1962010447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025366) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00618400) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2022-11-25 |