| NPI | 1780246223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 026612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006775RX) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2021-05-11 |