| NPI | 1043093230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009692) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 1210557) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-11-12 |