| NPI | 1902632565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 035023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00897900) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2026-04-05 |