| NPI | 1003289901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 021626) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: DC PA031203) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2021-02-01 |