| NPI | 1538322193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 012469) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2021-03-31 |