| NPI | 1124765581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028768-01) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2023-04-24 |