| NPI | 1518264761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3014) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014485) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2024-10-03 |