| NPI | 1972688612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 1088) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 002765) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |