| NPI | 1235505413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011694) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001694) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |