| NPI | 1679994529 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056682) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028078) |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2026-03-27 |