| NPI | 1083733869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011428) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA054486) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2011-05-03 |