| NPI | 1659631810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 003240-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 332) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2016-12-03 |