| NPI | 1053671859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107146) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 23015613) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2020-03-07 |