| NPI | 1730539669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027890-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002384) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-08-18 |