| NPI | 1639351281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053025) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 349540-1) |
| 363A00000X Physician Assistant (Licence: NY 004087-1) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |