| NPI | 1578751228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03632) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 012620) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2008-08-13 |