| NPI | 1558543157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 013277) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053256) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2014-02-20 |