| NPI | 1275936254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017922) |
| 363A00000X Physician Assistant (Licence: MT 74905) | |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2023-03-22 |