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 |