NPI | 1124078449 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002071) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00138500) |
363A00000X Physician Assistant (Licence: NY 009684) | |
Enumeration Date | 2006-05-10 |
Last Update Date | 2014-08-08 |