| NPI | 1639509268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 017148) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107653) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2015-08-27 |