| NPI | 1104243930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5325) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017460) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2015-05-10 |