| NPI | 1003536277 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 030492) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 5865) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2023-12-28 |