| NPI | 1053631036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004752) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 013958-1) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2013-04-30 |