| NPI | 1063782712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107152) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015311) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 015311-1) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107152) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2022-10-12 |