| NPI | 1639512999 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101258988) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 316114) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2023-07-22 |