| NPI | 1730685546 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9603) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021960) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 021960) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2020-08-27 |