| NPI | 1932487923 |
|---|---|
| Former Name | JENNIFER NICOLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 009222-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 0092221) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |