| NPI | 1780704783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007698) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14099) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2026-04-09 |