| NPI | 1740897461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9398) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 027465) |
| Enumeration Date | 2020-09-27 |
| Last Update Date | 2023-09-19 |