| NPI | 1184794364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 006187) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 6187) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 2679) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-04-03 |