| NPI | 1386360410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14245) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NY 029029) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2025-10-16 |