| NPI | 1316491418 |
|---|---|
| Former Name | LAURA BOLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020009) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY P03035) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2021-02-08 |