| NPI | 1548221963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9104152) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 23-011150) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2009-06-02 |