| NPI | 1477712610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012385) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054812) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2011-09-02 |