| NPI | 1124215595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002097) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2011-03-15 |