NPI | 1235793852 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9116212) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024116) |
Enumeration Date | 2019-04-29 |
Last Update Date | 2022-08-02 |