| NPI | 1083948970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 15777) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 76893021206) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2012-09-26 |