| NPI | 1790322774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 11708) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024558) |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2024-09-23 |