| NPI | 1104450097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025505) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2025-12-04 |