| NPI | 1104000504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00314) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2009-11-12 |