| NPI | 1063458941 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-00752) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010625-1) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-03-17 |