| NPI | 1699179846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55187) |
| Additional Taxonomies | 282E00000X (Licence: NY 23018128) |
| 363A00000X Physician Assistant (Licence: NY 23018128) | |
| 281P00000X Chronic Disease Hospital (Licence: NY 23018128) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 23018128) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 23018128) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2021-01-26 |