| NPI | 1942677612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9108943) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 018977) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2016-09-21 |