| NPI | 1962117010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA064216) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 029401) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2023-04-20 |