| NPI | 1457011330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12447) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 027860) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2022-10-13 |