| NPI | 1962888248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA057236) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 019651) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2022-08-03 |