| NPI | 1083993919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1395) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015183) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2018-09-28 |