| NPI | 1164091096 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118798) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 026628) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-04-22 |