| NPI | 1255519617 |
|---|---|
| Former Name | IRINA BASOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0064151) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 006415) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-07-11 |