| NPI | 1306198445 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016113) |
| Enumeration Date | 2012-10-14 |
| Last Update Date | 2014-10-23 |