| NPI | 1245400126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 017506-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053342) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 001003668) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2015-01-04 |