| NPI | 1649921305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028146) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: DC PA200001473) | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-03-11 |