| NPI | 1275139206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029518-01) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-12-06 |
| Last Update Date | 2023-07-04 |