| NPI | 1689128613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 024662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004735RX) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2021-10-06 |