| NPI | 1477804854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA056858) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016055) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2015-01-01 |