| NPI | 1962863464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 23019554) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 4435) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2024-02-19 |