| NPI | 1780908186 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL 829) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013914) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2018-03-17 |