| NPI | 1487282133 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15522) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025636) | 
| Enumeration Date | 2020-03-30 | 
| Last Update Date | 2025-07-29 |