| NPI | 1023605912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 026190) |
| Enumeration Date | 2020-12-24 |
| Last Update Date | 2023-01-24 |