| NPI | 1457793101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016588) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016588) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2019-11-20 |