| NPI | 1023183993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 09) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 000558-1) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |