| NPI | 1972192540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026319) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NC 0010-12818) | |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2025-08-22 |