| NPI | 1912328063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017164-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00335000) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2025-08-22 |