| NPI | 1376940106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 018189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA51821) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2014-11-21 |