| NPI | 1477701910 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA002917) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053544) |
| 363AM0700X Physician Assistant Medical (Licence: NY 013269-1) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2012-09-13 |