| NPI | 1568855591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018549) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QP3300X Clinic/Center, Pain | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2017-04-29 |