| NPI | 1114041167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA 052901) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 000762) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2009-10-01 |