| NPI | 1245392331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053949) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010280) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2010-01-13 |