| NPI | 1679123301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024192) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-09-15 |
| Last Update Date | 2025-08-13 |