| NPI | 1962557207 |
|---|---|
| Former Name | LAVINA JOSE JACOB |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 011516) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011516) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-12-18 |