| NPI | 1275849085 |
|---|---|
| Former Name | JENNIFER MCNICHOLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014471-1) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2011-12-06 |