| NPI | 1174758411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015643) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 015150-1) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2021-01-08 |