| NPI | 1972809044 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 014596-1) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: NY 006528-1) |
| 363AM0700X Physician Assistant, Medical (Licence: WV 01753) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2014-12-19 |