NPI | 1003658691 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 031949) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2024-06-12 |
Last Update Date | 2025-05-02 |