| NPI | 1114595105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027040) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-08-17 |