| NPI | 1518954635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008799) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00135200) |
| 363A00000X Physician Assistant (Licence: NY 008799-1) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2010-07-12 |