| NPI | 1972105898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 027233) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA062138) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2021-10-08 |