| NPI | 1366616013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 011809) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NY 012365) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2021-03-10 |