| NPI | 1992053151 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7353) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23015880) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2020-11-05 |