| NPI | 1477893741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055970) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016339-1) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2015-01-28 |