| NPI | 1235766312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13905) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025912) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-02-28 |