| NPI | 1679909618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057537) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016836) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2018-07-19 |