| NPI | 1659601649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007388) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013821) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2017-01-10 |